Heart and Vessels

, Volume 34, Issue 2, pp 218–226 | Cite as

Obesity paradox in the era of percutaneous coronary intervention with 2nd-generation drug-eluting stents: an analysis of a multicenter PCI registry

  • Daisuke Ueshima
  • Shunji Yoshikawa
  • Taro Sasaoka
  • Yu Hatano
  • Ken Kurihara
  • Yasuhiro Maejima
  • Mitsuaki Isobe
  • Takashi AshikagaEmail author
Original Article


Being overweight has been identified as independent risk factors for coronary artery disease. However, overweight patients have been reported frequently to have better mortality outcomes, and there is little data showing they are at a disadvantage regarding secondary prevention of cardiovascular events. We analyzed the influence of being overweight (defined as body mass index > 25 kg/m2) on adverse events in patients who underwent everolimus-eluting stent (EES) implantation using a multicenter registry with a maximum follow-up of 3 years. Propensity score matching was done for adjusting baseline characteristics. We defined primary end points as major adverse cardiac and cerebrovascular events (MACCE: a composite of mortality from all causes, nonfatal myocardial infarction, and nonfatal stroke) and “MACCE excluding non-cardiac mortality”. Other adverse events were analyzed as key secondary end points. Out of 1918 patients, 450 pairs were obtained through propensity score matching. Overweight patients were superior to non-overweight patients regarding MACCE (event rates: 8.2 vs. 13.8% in overweight vs. non-overweight, respectively; log-rank p = 0.009) and “MACCE excluding non-cardiac mortality” (5.9 vs. 10.1%, p = 0.03). On secondary end points, not only did overweight patients have significantly fewer major bleeding events (2.2 vs. 4.8%, p = 0.02), but they also had smaller adverse event rates for almost all such events; the differences were not statistically significant. Overweight patients had better outcomes for MACCE, even on excluding non-cardiac mortalities. No result was supportive of an evident advantage to non-overweight EES-implanted patients in terms of secondary prevention of cardiovascular events.


Percutaneous coronary intervention Overweight Obesity Drug-eluting stent Mortality Major adverse cardiac or cerebrovascular events 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

380_2018_1234_MOESM1_ESM.pdf (1.6 mb)
Supplementary material 1 (PDF 1672 kb)


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Daisuke Ueshima
    • 1
  • Shunji Yoshikawa
    • 2
  • Taro Sasaoka
    • 1
  • Yu Hatano
    • 1
  • Ken Kurihara
    • 3
  • Yasuhiro Maejima
    • 1
  • Mitsuaki Isobe
    • 4
  • Takashi Ashikaga
    • 1
    Email author
  1. 1.Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of CardiologyYamate Medical CenterTokyoJapan
  3. 3.Ome Municipal General HospitalOmeJapan
  4. 4.Sakakibara Memorial HospitalFuchuJapan

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